Publications by authors named "Jaouad Azzahhafi"
Cost-effectiveness of Implementing a Genotype-Guided De-Escalation Strategy in Patients with Acute Coronary Syndrome.
Eur Heart J Cardiovasc Pharmacother
November 2024
Aims: A genotype-guided P2Y12-inhibitor de-escalation strategy, switching acute coronary syndrome (ACS) patients without a CYP2C19 loss-of-function allele from ticagrelor or prasugrel to clopidogrel, has shown to reduce bleeding risk without affecting effectivity of therapy by increasing ischemic risk. We estimated the cost-effectiveness of this personalized approach compared to standard dual antiplatelet therapy (DAPT; aspirin plus ticagrelor/prasugrel) in the Netherlands.
Methods And Results: We developed a one-year decision tree based on results of the FORCE-ACS registry, comparing a cohort of ACS patients who underwent genotyping with a cohort of ACS patients treated with standard DAPT.
Article Synopsis
- The study investigates the frequency and reasons for changes in ticagrelor treatment among patients with acute coronary syndrome (ACS), revealing that many patients discontinue it prematurely.
- Data from over 4,200 patients showed that 26.7% had physician-recommended discontinuations and 20.1% had alterations in their treatment within a year.
- Treatment interruptions and disruptions significantly increased the risk of serious heart-related issues, while discontinuation and alterations did not show the same level of risk.
Background: Accurate bleeding risk stratification after percutaneous coronary intervention (PCI) is important for treatment individualization. However, there is still an unmet need for a more precise and standardized identification of high bleeding risk patients. We derived and validated a novel bleeding risk score by augmenting the PRECISE-DAPT score with the Academic Research Consortium for High Bleeding Risk (ARC-HBR) criteria.
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- The study investigated whether using CYP2C19 genetic testing to guide medication choices improves outcomes for patients with acute coronary syndrome (ACS) compared to standard treatment.
- Out of 5,321 ACS patients, those who were genotyped and had their medications tailored showed significantly lower bleeding rates while maintaining a similar risk of ischemic events compared to those on standard therapy.
- The findings suggest that a personalized approach to antiplatelet therapy based on genetic markers can enhance safety without compromising efficacy in managing ACS.
Background: Acute coronary syndrome (ACS) is frequently accompanied by newly diagnosed atrial fibrillation (AF).
Aims: We aimed to compare the risk of major adverse cardiovascular events (MACE) in ACS patients presenting with known, newly diagnosed, or no AF.
Methods: In our multicentre, prospective registry study, we included patients with confirmed ACS.
Article Synopsis
- The study compares ambulance paramedics' use of the modified HEART-score with point-of-care cardiac troponin testing to emergency physicians' use of the same score with high-sensitive cTn in patients suspected of having non-ST-elevation acute coronary syndrome (NSTE-ACS).
- It evaluates the interobserver agreement and diagnostic performance of four different cTn testing strategies, aiming to improve the accuracy of NSTE-ACS diagnoses and reduce unnecessary hospitalizations.
- The POPular HEART study seeks to enhance pre-hospital detection of NSTE-ACS, ultimately aiming to lower healthcare costs and improve patient outcomes.
Background: Guidelines recommend prasugrel or ticagrelor for acute coronary syndrome (ACS) patients. However, these P2Y inhibitors increase bleeding risk compared to clopidogrel. Although genotype-guided P2Y-inhibitor selection has been shown to reduce bleeding risk, data on its clinical implementation is lacking.
View Article and Find Full Text PDFThis registry assessed the impact of conservative and invasive strategies on major adverse clinical events (MACE) in elderly patients with non-ST-elevation myocardial infarction (NSTEMI). Patients aged ≥75 years with NSTEMI were prospectively registered from European centers and followed up for one year. Outcomes were compared between conservative and invasive groups in the overall population and a propensity score-matched (PSM) cohort.
View Article and Find Full Text PDFObjective: Patients with acute coronary syndrome (ACS) remain at high risk for recurrent ischaemic and bleeding events during follow-up. Our study aimed to quantify and compare the impact of these adverse events on quality of life (QoL).
Methods: Data from patients with ACS prospectively enrolled in the FORCE-ACS registry between January 2015 and December 2019 were used for this study.
Article Synopsis
- The LEGACY study examines whether stopping aspirin right after PCI for NSTE-ACS and using only P2Y-inhibitor therapy is safer and effective compared to continuing dual antiplatelet therapy (DAPT) for 12 months.
- The research involves 3,090 patients, comparing the incidence of bleeding events between those on aspirin and those who aren’t, while also ensuring no significant increase in serious health issues like heart attacks or strokes.
- This study is groundbreaking as it specifically investigates the effects of immediately omitting aspirin, making it a crucial step in understanding optimal post-PCI treatment options.
Background: The cytochrome P450 (CYP) 2C9 enzyme plays a role in the metabolization of clopidogrel. Carriage of a CYP2C9 loss-of-function (LoF) allele has been associated with attenuated pharmacokinetics, leading to a diminished pharmacodynamic response and increased risk for developing stent thrombosis in patients treated with clopidogrel.
Methods: In this study, we aimed to determine the effect of the CYP2C9*2 and *3 LoF alleles on thrombotic events.
Article Synopsis
- The study aimed to assess the clinical efficacy and side effects of ticagrelor in patients with varying CYP3A5 gene status, specifically looking at thrombotic and bleeding events, as well as dyspnea.
- A total of 1,281 STEMI patients were genotyped, revealing no significant differences in thrombotic or bleeding outcomes between carriers and non-carriers of the gene, nor between CYP3A5 expressors and non-expressors.
- Overall, ticagrelor showed no statistical significance in affecting thrombotic events, bleeding rates, or dyspnea among the different genetic groups studied.
Objectives: To validate the Global Registry of Acute Coronary Events (GRACE) risk score and examine the extent and impact of the risk-treatment paradox in contemporary patients with acute coronary syndrome (ACS).
Methods: Data from 5015 patients with ACS enrolled in the FORCE-ACS registry between January 2015 and December 2019 were used for model validation. The performance of the GRACE risk score for predicting in-hospital and 1-year mortality was evaluated based on indices of model discrimination and calibration.
Although current literature indicates both a clinical and a cost-effective benefit of routine genotype-guided treatment of patients treated with clopidogrel, this strategy is not recommended in guidelines. In cardiology, but also in neurology and vascular surgery, the current scientific evidence for this is still insufficient. Nevertheless, the role of pharmacogenetics will gain importance in today's medical world, where the demand for personalised medicine is on the rise.
View Article and Find Full Text PDFRationale and Design of the Future Optimal Research and Care Evaluation in Patients with Acute Coronary Syndrome (FORCE-ACS) Registry: Towards "Personalized Medicine" in Daily Clinical Practice.
J Clin Med
September 2020
Diagnostic and treatment strategies for acute coronary syndrome have improved dramatically over the past few decades, but mortality and recurrent myocardial infarction rates remain high. An aging population with increasing co-morbidities heralds new clinical challenges. Therefore, in order to evaluate and improve current treatment strategies, detailed information on clinical presentation, treatment and follow-up in real-world patients is needed.
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- Risk scores are key tools used in assessing patients with acute coronary syndrome (ACS) to predict the likelihood of adverse cardiac events and guide treatment options based on their risk level.
- Initial assessments help decide whether low-risk patients can be discharged or if high-risk patients need immediate care.
- The review highlights important risk scores that have evolved over the years to aid in managing ACS patients both during and after hospitalization.